Family and Child Involvement and Retention in Youth Mental Health

Q: What is your strategy for assessing the strengths of the child, family and community?

A: We use a multi-phase systemic approach. When a youth is referred to the program, Massachusetts Mental Health Services Program for Youth (MHSPY), we have extensive conversations with the system's partners to clarify the understanding of the youth's needs and the referring agency's goals. Additionally, we speak to the youth, the youth's family and all the systems involved (i.e., teacher, pediatrician, therapist).

We use a narrative interview approach, which allows people to tell their stories, and an array of standardized instruments (e.g., Child and Adolescent Functional Assessment Scale; Child Behavior Checklist; Youth Self Report) to assess each child. We explore the dynamics at home, in school, involvement in sports teams and other areas that help us gain insight into the child's environment. All this takes place before the youth is enrolled; once the youth comes into the program, s/he is followed by a clinician who conducts a strength-based needs assessment with the Care Planning team.

The team includes the child's caregiver, care manager, referring agent, and other providers, including teachers, therapists, psychiatrists, physicians, parole officers, and informal supports designated by the caregiver. Through these combined resources, the team is able to define the mission that will focus its work.

Q: How is the staff trained to adapt to new and different cultural situations?

A: Our clinical staff must have at least master's-level clinical training and extensive experience in working with youth and families in urban settings. MHSPY works with a low-income, Medicaid-eligible population in five ethnically diverse urban towns in Massachusetts. Many have an intergenerational history of mental illness, substance abuse, serious medical conditions, and cognitive disabilities. These factors make it particularly challenging to deliver care.

We promote a supportive environment with an individual clinical supervisor for every five to six MHSPY clinicians, and weekly group supervision. The staff regularly engages in formal peer discussions and reflective practice. We also hold day-long, program-development trainings each month. The staff is trained not only to identify and become competent in the diversities of society at large, but to do so within the context of the family's unique norms and customs. In addition, when appropriate we refer children to community providers who reflect and are part of their demographic subgroups.

Q: What are the key factors in participant retention?

A: Active participation of families in the MHSPY process is a priority that guides clinician and programmatic communication from the referral stage through termination or "graduation." MHSPY defines three distinct clinical phases within the overall process:

Initiation: During the initiation phase, the Care Planning team is introduced to the concept of defining a measurable set of objectives, or mission. This mission guides the work of the team throughout enrollment. No two missions are the same. Examples of actual mission statements are: "[6-year-old boy] will not engage in unsafe behaviors such as climbing on furniture, touching the stovetop, throwing things at others, running away, or refusing to hold an adult's hand when needed. He will be able to cope better with transitions; [17-year-old girl] will increase her life skills by graduating high school, and learning job skills that will lead to a job and increase her independence."

Engagement: In the engagement phase the Care Planning team develops goals and interventions that support the mission. Each member takes responsibility for supporting the agreed upon goals. For example, one pediatrician used the team to talk to a child about medication management and follow-up care for her severe iron deficiency. During the engagement phase, the work is fine-tuned as the interventions are carried out and goals addressed and met.

Transition: The transition phase refers to the work that identifies successes as well as remaining needs. During this phase, the Care Planning team outlines and plans for the work to come after a child leaves the program. The team also clarifies expectations in all the youth's life domains. The team aims to create a plan that is clear and sustainable.